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Thibedeau M, Fish J, Kelly C, Wenskus J, Zuccaro J, Gus E. Timing of nanocrystalline silver-based dressing application - A retrospective single-center pediatric cohort study. J Burn Care Res 2024:irae056. [PMID: 38578062 DOI: 10.1093/jbcr/irae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Indexed: 04/06/2024]
Abstract
Recent evidence has demonstrated that silver has anti-inflammatory properties that are independent from the known antimicrobial ones. In our current model of care, non-adherent, non-silver dressings are applied for acute presentations of pediatric partial thickness burn injuries. The wounds are re-assessed after the progression phase (48-72 hours after injury) and silver dressings are applied. However, when logistical obstacles prevent re-assessment within the 48-72-hour window, nanocrystalline silver-based dressings are applied on presentation. The objective of this study was to test our model of care. We hypothesized that immediate application (< 24 hours after injury) of nanocrystalline silver-based dressings would reduce surgical interventions. This was a retrospective single-center cohort study. All patients <18 years old treated at a pediatric burn center for acute partial thickness burn injuries, between January 1, 2020, and December 31, 2021 were included. Multivariable logistic regression was used to compare surgical treatment rates between patients with different timing of nanocrystalline silver-based dressing application. Four hundred seventy-six patients were included for analysis. One hundred four (21.8%) had nanocrystalline silver-based dressings and 372 (78.2%) had non-silver non-adherent dressings applied within 24 hours of injury. Multivariable logistic regression identified three statistically significant variables as predictors for surgical treatment: age (OR = 1.14, 95% CI [1.06-1.23]), total body surface area (OR = 1.15, 95% CI [1.06-1.25]), and burns to buttocks/lower extremity (OR = 2.39, 95% CI [1.26-4.53]). Immediate (< 24 hours after injury) application of nanocrystalline silver-based dressings does not affect surgical treatment rate in pediatric patients with partial thickness burns.
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Affiliation(s)
- Marshall Thibedeau
- Division of Plastic, Reconstructive & Aesthetic Surgery, Toronto, Canada
| | - Joel Fish
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada. Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charis Kelly
- Division of Plastic and Reconstructive Surgery, Burn Program, The Hospital for Sick Children, Toronto, Canada. Faculty of Nursing, Univeristy of Toronto, Toronto, Canada
| | - Julia Wenskus
- Department of Plastic and Reconstructive Surgery, Pediatric Burn Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jennifer Zuccaro
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Eduardo Gus
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada. Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. SickKids Research Institute, University of Toronto, Toronto, Canada
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Yang X, Zheng E, Sun X, Reynolds A, Gonzalez M, Villamil JH, Pando BD, Smith DJ, Yuan SY, Wu MH. C-TYPE LECTIN-2D RECEPTOR CONTRIBUTES TO HISTONE-INDUCED VASCULAR BARRIER DYSFUNCTION DURING BURN INJURY. Shock 2024; 61:592-600. [PMID: 37878490 PMCID: PMC10997737 DOI: 10.1097/shk.0000000000002237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Severe burns are associated with massive tissue destruction and cell death where nucleus histones and other damage-associated molecular patterns are released into the circulation and contribute to the pathogenesis of multiple-organ dysfunction. Currently, there is limited information regarding the pathophysiology of extracellular histones after burns, and the mechanisms underlying histone-induced vascular injury are not fully understood. In this study, by comparing the blood samples from healthy donors and burn patients, we confirmed that burn injury promoted the release of extracellular histones into the circulation, evidenced by increased plasma levels of histones correlating with injury severity. The direct effects of extracellular histones on human endothelial monolayers were examined, and the results showed that histones caused cell-cell adherens junction discontinuity and barrier dysfunction in a dose-related manner. Like burn patients, mice subjected to a scald burn covering 25% total body surface area also displayed significantly increased plasma histones. Intravital microscopic analysis of mouse mesenteric microcirculation indicated that treatment with a histone antibody greatly attenuated burn-induced plasma leakage in postcapillary venules, supporting the pathogenic role of extracellular histones in the development of microvascular barrier dysfunction during burns. At the molecular level, intrigued by the recent discovery of C-type lectin domain family 2 member D (Clec2d) as a novel receptor of histones, we tested its potential involvement in the histone interaction with endothelial cells. Indeed, we identified abundant expression of Clec2d in vascular endothelial cells. Further proximity ligation assay demonstrated a close association between extracellular histones and endothelial expressing Clec2d. Functionally, in vivo administration of an anti-Clec2d antibody attenuated burn-induced plasma leakage across mesenteric microvessels. Consistently, Clec2d knockdown in endothelial cells partially inhibited histone-induced endothelial barrier dysfunction. Together, our data suggest that burn injury-induced increases in circulating histones contribute to microvascular leakage and endothelial barrier dysfunction via a mechanism involving the endothelial Clec2d receptor.
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Affiliation(s)
- Xiaoyuan Yang
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Ethan Zheng
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Xiaoqi Sun
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Amanda Reynolds
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Monica Gonzalez
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Juan Hernandez Villamil
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Briana D. Pando
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - David J. Smith
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sarah Y. Yuan
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Mack H. Wu
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- James A Haley Veterans’ Hospital, Tampa, Florida
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Wong E, Dodson N, Wagner S, Thornton S. Time to Burn? Characteristics of Hydroxocobalamin Administration in an Academic Medical Center. J Pharm Pract 2024; 37:369-373. [PMID: 36318086 DOI: 10.1177/08971900221136633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background/Objective: Hydroxocobalamin is indicated for cyanide poisoning and its package insert states it should be given "without delay". We sought to evaluate time to administration and clinical characteristics when hydroxocobalamin was administered in a quaternary care academic medical center. Methods: All hydroxocobalamin administrations from January 1, 2007 to December 31, 2018 were analyzed. Data points recorded were: carboxyhemoglobin, cyanide and methemoglobin levels, hospital time and course, time and dose of hydroxocobalamin administration, lactate and bicarbonate levels, initial and nadir pH, initial heart rate, and initial and lowest systolic blood pressure. Results: Fifty-six cases were identified. One case was excluded as hydroxocobalamin was administered for nitroprusside toxicity. Among 55 cases analyzed, 93% (n = 51) were adults. Median hospital length of stay was 4.3 days (IQR 2.5 to 12). Burn, inhalation injury, and smoke inhalation were 80% of admitting diagnoses. Median time to hydroxocobalamin administration was 208 minutes (IQR 62.5 to 330). Eleven of 55 cases died. Hydroxocobalamin was given within 60 minutes of arrival in 12 cases, of which 3 died. All adults received 5 g of hydroxocobalamin. Time to hydroxocobalamin administration was longer in death cases [median: 221 minutes (IQR 119 to 594)] vs survivors [median: 184.5 minutes (IQR 62.8 to 315)]. Seventeen cases had cyanide levels drawn, with 9 being measurable, but none were toxic. Conclusions: Significant delay in hydroxocobalamin administration was seen in this study. Cases that resulted in death had significantly longer times to hydroxocobalamin administration. Further studies are warranted to identify reasons for delays in hydroxocobalamin administration.
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Affiliation(s)
- Edric Wong
- Department of Pharmacy, University of Kansas Health System, Kansas City, KS, USA
| | - Nicholas Dodson
- Department of Pharmacy, University of Kansas Health System, Kansas City, KS, USA
| | - Sam Wagner
- Department of Emergency Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Stephen Thornton
- Department of Emergency Medicine, University of Kansas Health System, Kansas City, KS, USA
- Kansas Poison Control Center, University of Kansas Health System, Kansas City, KS, USA
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Zhu D, Hu Y, Kong X, Luo Y, Zhang Y, Wu Y, Tan J, Chen J, Xu T, Zhu L. Enhanced burn wound healing by controlled-release 3D ADMSC-derived exosome-loaded hyaluronan hydrogel. Regen Biomater 2024; 11:rbae035. [PMID: 38628545 PMCID: PMC11018541 DOI: 10.1093/rb/rbae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/23/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Adipose mesenchymal stem cell (ADMSC)-derived exosomes (ADMSC-Exos) have shown great potential in regenerative medicine and been evidenced benefiting wound repair such as burns. However, the low yield, easy loss after direct coating, and no suitable loading system to improve their availability and efficacy hinder their clinical application for wound healing. And few studies focused on the comparison of biological functions between exosomes derived from different culture techniques, especially in exosome-releasing hydrogel system. Therefore, we designed a high-performance exosome controllable releasing hydrogel system for burn wound healing, namely loading 3D-printed microfiber culture-derived exosomes in a highly biocompatible hyaluronic acid (HA). In this project, we compared the biological functions in vitro and in a burn model among exosomes derived from the conventional two-dimensional (2D) plate culture (2D-Exos), microcarrier culture (2.5D-Exos), and 3D-printed microfiber culture (3D-Exos). Results showed that compared with 2D-Exos and 2.5D-Exos, 3D-Exos promoted HACATs and HUVECs cell proliferation and migration more significantly. Additionally, 3D-Exos had stronger angiogenesis-promoting effects in tube formation of (HUVECs) cells. Moreover, we found HA-loaded 3D-Exos showed better burn wound healing promotion compared to 2D-Exos and 2.5D-Exos, including accelerated burn wound healing rate and better collagen remodeling. The study findings reveal that the HA-loaded, controllable-release 3D-Exos repair system distinctly augments therapeutic efficacy in terms of wound healing, while concurrently introducing a facile application approach. This system markedly bolsters the exosomal loading efficiency, provides a robust protective milieu, and potentiates the inherent biological functionalities of the exosomes. Our findings provide a rationale for more efficient utilization of high-quality and high-yield 3D exosomes in the future, and a novel strategy for healing severe burns.
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Affiliation(s)
- Delong Zhu
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Ying Hu
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Xiangkai Kong
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yuansen Luo
- Department of the Second Plastic Surgery, The First People’s Hospital of Foshan, Foshan 528000, China
| | - Yi Zhang
- Department of Research and Development, Huaqing Zhimei (Shenzhen) Biotechnology Co., Ltd, Shenzhen 518107, People’s Republic of China
| | - Yu Wu
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jiameng Tan
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jianwei Chen
- Center for Bio-Intelligent Manufacturing and Living Matter Bioprinting, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen 518057, People’s Republic of China
| | - Tao Xu
- Center for Bio-Intelligent Manufacturing and Living Matter Bioprinting, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen 518057, People’s Republic of China
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, People’s Republic of China
| | - Lei Zhu
- Department of Dermatology & Plastic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Bostancı SA, Demir S, Ertürk A, Demirtaş G, Öztorun Cİ, Güney D, Demirkaya Ş, Erten EE, Azılı MN, Şenel E. Management of outpatient pediatric burns at a pediatric burn center. J Burn Care Res 2024:irae043. [PMID: 38477148 DOI: 10.1093/jbcr/irae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Indexed: 03/14/2024]
Abstract
Burn injuries are a serious emergency. Most burn injuries in children can be treated as outpatients. The aim of this study was to present the clinical and epidemiologic characteristics of pediatric burn injuries treated in our outpatient burn clinic. This study included pediatric patients treated in an outpatient burn clinic over an eight-year period. The demographic and clinical characteristics of the patients were retrospectively analyzed. The patients were divided into four groups according to their age groups, and the differences between the groups were investigated. Statistical analysis was performed using IBM SPSS Statistics, Version 25.0. P<0.05 was accepted as statistically significant. Of the total 5,167 patients, 2,811 (54.4%) were male. Scald burns were the most common cause of burns (81.4%). Contact burns accounted for 12.2% of all burns. There were no differences between sexes for any variable. The highest incidence was seen in children in the 2-5-year-old age group (28.3%). There were differences between age groups in terms of sex, burn area, burn visit, burn type, burn location, need for wound dressing under anesthesia, and need for grafting. Among the patients, 4.9% were hospitalized due to the need for wound dressing under anesthesia. However, most of the patients (95.1%) were treated as outpatients. In conclusion, the majority of pediatric burn patients can be treated as outpatients. This allows pediatric patients to complete treatment in a psychologically comfortable environment and have low complication rates. Outpatient treatment should become the standard for children who are suitable for outpatient follow-up and who have home support.
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Affiliation(s)
- Süleyman Arif Bostancı
- Ankara Bilkent City Hospital, Childrens' Hospital, Deparment of Pediatric Surgery, Pediatric Burn Center, Ankara, Turkey
| | - Sabri Demir
- Health Science University, Ankara Bilkent City Hospital, Childrens' Hospital, Department of Pediatric Surgery, Pediatric Burn Center, Ankara, Turkey
| | - Ahmet Ertürk
- Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - Gökhan Demirtaş
- Ankara Bilkent City Hospital, Childrens' Hospital, Deparment of Pediatric Surgery, Ankara, Turkey
| | - Can İhsan Öztorun
- Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - Doğuş Güney
- Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - Şükrüye Demirkaya
- Ankara Bilkent City Hospital, Childrens' Hospital, Deparment of Pediatric Surgery, Ankara, Turkey
| | - Elif Emel Erten
- Ankara Bilkent City Hospital, Childrens' Hospital, Deparment of Pediatric Surgery, Ankara, Turkey
| | - Müjdem Nur Azılı
- Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - Emrah Şenel
- Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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Schwartzman A, Mueller SW, Ridgeway KJ, Balstad B, Wiktor AJ. The Integration of Physical Therapists and Occupational Therapists into Burn Wound Care Increases Therapist Productivity, Job Satisfaction, and Multidisciplinary Collaboration. J Burn Care Res 2024:irae041. [PMID: 38469886 DOI: 10.1093/jbcr/irae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 03/13/2024]
Abstract
When attempting to deliver specialized rehabilitation therapy interventions, physical therapists (PTs) and occupational therapists (OTs) must account for dynamic and logistical patient factors such as: daily wound care, pain, difficultly progressing range of motion with dressings donned, and ongoing surgical interventions. Additionally, they must attain institution-specific productivity standards. Given burn patients often require considerable multidisciplinary interventions, efficiently planning and delivering rehabilitation therapy interventions within productivity expectations may prove difficult. The purpose of this study was to assess the feasibility of integrating rehabilitation therapists, PTs and OTs, into daily burn wound care by investigating therapist productivity and multidisciplinary perceptions of this practice change. The quality improvement project involved six rehabilitation therapists (three PTs and three OTs) practicing exclusively in the burn unit within an American Burn Association (ABA) verified burn center at an urban, tertiary care academic medical center. One rehabilitation therapist was responsible for providing interventions within the burn wound care team five days a week. General duties included wound assessment, functional wound dressings, and skilled therapeutic interventions such as manual therapy, therapeutic exercise, and compression interventions. The primary outcome was changes in group productivity and individual therapist productivity, as measured by total billed CPT codes per hour worked, which were tracked 22 weeks pre- and 28 weeks post-implementation. Program feasibility and general perceptions were assessed by a qualitative questionnaire. For both the entire group of therapists and each individual rehabilitation therapist, billed CPT codes per hour increased post implementation, 1.81 versus 1.54 (p=0.005) and a matched increase of 0.27/hr (p=0.003). Of the 23 survey respondents, 96% had a favorable impression of the program and reported it eased staffing demands. All respondents reported improved unit workflow and multidisciplinary communication. The majority of multidisciplinary burn team members actively supported the pilot program and commented on improvements in patient care. Full-time rehabilitation therapy participation in wound care increases therapist productivity and job satisfaction. Future efforts, however, should focus on measuring specific patient outcomes and cost as a result of therapist integration into daily wound care practice.
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Affiliation(s)
- Amy Schwartzman
- Rehabilitation Therapy Department. University of Colorado Hospital. 12605 E 16th Ave, Aurora, CO 80045. United States of America
| | - Scott W Mueller
- Department of Pharmacy. University of Colorado Hospital. 12605 E 16th Ave, Aurora, CO 80045. United States of America
| | - Kyle J Ridgeway
- Rehabilitation Therapy Department. University of Colorado Hospital. 12605 E 16th Ave, Aurora, CO 80045. United States of America
| | - Blaire Balstad
- Department of Surgery. Division of GI, Trauma/ Burns, and Endocrine Surgery (GITES). University of Colorado Hospital. 12631 East 17th Ave, Suite 6111, Aurora, CO 80045. United States of America
| | - Arek J Wiktor
- Department of Surgery. Division of GI, Trauma/ Burns, and Endocrine Surgery (GITES). University of Colorado Hospital. 12631 East 17th Ave, Suite 6111, Aurora, CO 80045. United States of America
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7
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Piccoli P, Lucini F, Al-Hatmi AMS, Rossato L. Fusariosis in burn patients: A systematic review of case reports. Med Mycol 2024; 62:myae013. [PMID: 38379099 DOI: 10.1093/mmy/myae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.
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Affiliation(s)
- Paola Piccoli
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | - Fabíola Lucini
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | | | - Luana Rossato
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
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Özkaçmaz A, Dicle Y, Bayram Y, Parlak M, Akış F, Çallı İ. The Distribution and the Antimicrobial Susceptibility Features of Microorganisms Isolated From the Burn Wounds: A 10-Year Retrospective Analysis. J Burn Care Res 2024; 45:384-397. [PMID: 37847516 DOI: 10.1093/jbcr/irad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/18/2023]
Abstract
In this study, we aimed to evaluate the distribution features and antimicrobial susceptibility test results of the microorganisms isolated from the wounds of pediatric and adult patients with burn. The culture and susceptibility test results of the microorganisms, isolated from the wound swabs of the patients hospitalized in a tertiary-burn care center in 10-year period, were retrospectively screened on the microbiology department databases. Their distribution of isolated microorganisms regarding species and susceptibility test results were compared with previous studies. A total of 367 microorganisms, isolated from the burn wounds of 293 patients (13 ± 18.9 years, F/M: 0.93) (73 adults and 220 pediatric patients), were included in this study. A solitary agent was isolated in 239 (81.6%) patients, while 2 were isolated in 43 (14.7%) and 3 or more agents in 11 (3.8%). From these, 33% of the isolated microorganisms were gram-positive cocci, 61% were gram-negative bacteria, and 6% were Candida spp. The most common isolated microorganisms were Staphylococcus aureus (18.5%), Pseudomonas spp. (16.9%), and Escherichia coli (11.2%), while the least common was Streptococcus spp. (2.5%). Methicillin resistance was 15% among the S. aureus strains. No resistance was observed against levofloxacin, vancomycin, teicoplanin, linezolid, daptomycin, fusidic acid, and tigecycline in S. aureus strains. The highest resistance rates were observed against levofloxacin (64%), tobramycin (64%), pip/tazobactam (63%), imipenem (63%), and the lowest against colistin (5%) and ceftazidime (29%), among Pseudomonas spp. The most common causative agents in burn wound infections and their current antimicrobial susceptibility features should be well identified, in order for prevention of serious complications and optimal management the condition to occur.
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Affiliation(s)
- Ayşe Özkaçmaz
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Yalçın Dicle
- Department of Microbiology, Faculty of Medicine, Mardin Artuklu University, Mardin 47200, Turkey
| | - Yasemin Bayram
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Mehmet Parlak
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Feride Akış
- Department of Microbiology, Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep 27010, Turkey
| | - İskan Çallı
- Department of General Surgery, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
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9
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Warren JD, Hughes KM. Pharmacologic Management of Pediatric Burns. J Burn Care Res 2024; 45:277-291. [PMID: 37948608 DOI: 10.1093/jbcr/irad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 11/12/2023]
Abstract
Many pediatric patients with burn injuries may be initially treated in a hospital where pediatric specialized care, including resources and trained personnel may be limited. This includes resuscitation in adult emergency departments and inpatient care in mixed adult-pediatric burn units. The intent of this review is to provide a compilation of topics for the adult trained pharmacist or another healthcare practitioner on the management of pediatric patients with burn injuries. This article focuses on several key areas of pharmacologic burn management in the pediatric patient that may differ from the adult patient, including pain and sedation, fluid resuscitation, nutrition support, antimicrobial selection, anticoagulation, and inhalation injury. It is important that all clinicians have resources to help optimize the management of burn injuries in the pediatric population as, in addition to burn injury itself, pediatric patients have different pharmacokinetics and pharmacodynamics affecting which medications are used and how they are dosed. This article highlights several key differences between pediatric and adult patients, providing an additional resource to assist adult-trained pharmacists or other healthcare practitioners with making clinical decisions in the pediatric burn population.
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Affiliation(s)
- Jontae D Warren
- Ochsner Baptist-A Campus of Ochsner Medical Center, Pharmacy Department, New Orleans, LA, 70115, USA
| | - Kaitlin M Hughes
- Riley Hospital for Children, Pharmacy Department, Indianapolis, IN, 46202, USA
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Mahrhofer M, Weitgasser L, Schoeller T. Skin-sharing Augmentation Mastopexy for Reconstruction of an Adult Female Breast After Severe Childhood Scalds: A Case Report. J Burn Care Res 2024; 45:508-511. [PMID: 38126967 DOI: 10.1093/jbcr/irad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Indexed: 12/23/2023]
Abstract
This case report describes our treatment of a 37-year-old female, Caucasian patient with a severe unilateral breast deformity after childhood scald trauma. Thermal injuries of the breast in female children pose a challenge for breast reconstruction after puberty since they impede normal development and can lead to psychological trauma. To achieve satisfactory results, a combination of different reconstructive techniques and a multistage approach is required. The patient was initially treated with an augmentation mastopexy of the left breast and a reverse abdominoplasty to correct the asymmetry and replace resected scar tissue. Following the surgery, skin necrosis of the lower breast pole due to insufficient perfusion of the skin occurred. A full-thickness skin graft, using the resected tissue from the healthy right breast after mastopexy, was used for reconstruction. This resulted in a successful outcome and proved to be a possible primary choice as well as a helpful option for salvage procedures. To our knowledge, this is the first case report describing the use of a contralateral mastopexy using the full-thickness skin graft for reconstruction of a burned breast.
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Affiliation(s)
- Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, 70199 Stuttgart, Germany
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, 70199 Stuttgart, Germany
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, 70199 Stuttgart, Germany
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Falksen JA, Young SR, Lee JA. Comparison of Continuous Sedatives in the Burn ICU on Delirium and Coma. J Burn Care Res 2024; 45:410-415. [PMID: 37875372 DOI: 10.1093/jbcr/irad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 10/26/2023]
Abstract
Lighter sedation targets over the past decade have resulted in improved outcomes for critically ill populations. Although guidelines exist for the general ICU population, these recommendations often exclude the burn population. The purpose of this study is to assess the impact of the initial continuous sedative on coma- and delirium-free days in critically ill patients with burns. This retrospective cohort study evaluated adult patients admitted to a burn intensive care unit at an academic medical center between January 2010 and September 2019. Patients were enrolled into 3 groups based on the depth of initial continuous sedation received (deep, light, or analgosedation). Intubated patients were randomly assessed for inclusion from the National V6 Burn Registry. Patients were included if they received a continuous sedative infusion for at least 48 h. A total of 107 patients were included in the study with 36, 41, and 30 patients receiving deep, light, and analgosedation, respectively. The primary outcome of coma- and delirium-free days was significantly different between sedation types with the most days free in analgosedation and the fewest in deep sedation (8 versus 3 days; P = 0.024). The composite primary outcome was divided into secondary outcomes of coma-free days and delirium-free days, with coma-free days being different (P = 0.00008). Other secondary outcomes of length of stay in the intensive care unit and hospital, time on mechanical ventilation, and survival to discharge were not statistically significant; however, a trend toward higher mortality in deep sedation was noted.
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Affiliation(s)
- Jessica A Falksen
- Department of Pharmacy Services, University of California Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - Sierra R Young
- Department of Pharmacy Services, University of California Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817, USA
| | - Jin A Lee
- Department of Pharmacy Services, University of California Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817, USA
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12
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Liu L, Liu Z, Zhu H, Xu H. Effect of quality nursing intervention on wound healing in patients with burns: A meta-analysis. Int Wound J 2024; 21:e14717. [PMID: 38439182 PMCID: PMC10912375 DOI: 10.1111/iwj.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
This meta-analysis aimed to explore the effects of quality nursing intervention on wound healing in patients with burns. A computerised search was conducted for randomised controlled trials (RCTs) on the effect of quality nursing intervention on wound healing in patients with burns in the PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases from the date of database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on the inclusion and exclusion criteria. Stata 17.0 software was used for the data analysis. Twenty-nine RCTs involving 2637 patients with burns were included. The meta-analysis revealed that compared with conventional nursing, the implementation of quality nursing intervention in patients with burns significantly shortened the wound healing time (standardised mean difference [SMD] = -2.93, 95% confidence interval [CI]: -3.44 to -2.42, p < 0.001). The incidence of wound infections (odds ratio [OR] = 0.14, 95% CI: 0.07-0.27, p < 0.001) and complications (OR = 0.16, 95% CI: 0.11-0.23, p < 0.001) was also reduced significantly. This meta-analysis shows that applying quality nursing interventions in patients with burns can significantly shorten the wound healing time and reduce the incidence of wound infection and complications, thus promoting early patient recovery.
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Affiliation(s)
- Ling Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Zhu‐Feng Liu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Hong‐Yu Zhu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Hui‐Qin Xu
- Department of BurnPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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13
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Haghighi Bardineh SA, Balou HA, Sedigh Ebrahim‐Saraie H, Mobayen M, Esmailzadeh M, Haghighi S, Haghighi A, Sadeghi M. Predictive value of serum albumin and calcium levels in burn patients with Pseudomonas aeruginosa infection: A comprehensive analysis of clinical outcomes. Int Wound J 2024; 21:e14786. [PMID: 38385765 PMCID: PMC10883257 DOI: 10.1111/iwj.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.
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Affiliation(s)
| | - Heydar Ali Balou
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Hadi Sedigh Ebrahim‐Saraie
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mojdeh Esmailzadeh
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Samane Haghighi
- Institute of Theoretical and Translational MedicineSemmelweis UniversityBudapestHungary
| | - Arezoo Haghighi
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical SciencesSemmelweis UniversityBudapestHungary
| | - Mahsa Sadeghi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
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14
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Choi JY, Joo YJ, Kang RJ, Jeon HK, Hong GS. Effect of Spray-Type Alginate Hydrogel Dressing on Burn Wounds. Gels 2024; 10:152. [PMID: 38391482 PMCID: PMC10888430 DOI: 10.3390/gels10020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Immediate burn wound care is a critical factor influencing the outcomes of burn treatment. In this study, we developed a spray-type alginate hydrogel dressing that promotes wound healing, reduces pain, and increases the convenience of use in a burn treatment emergency. We investigated the efficiency of newly developed spray-type alginate hydrogel dressing on the wound healing process. We investigated the efficacy of the alginate hydrogel dressing for wound healing in 30 Sprague Dawley rats. Four deep, round second-degree burn wounds (diameter, 1.5 cm) were created bilaterally on the dorsum of the rat's trunk; the rats were divided into four groups, in which different dressing materials were applied as follows: group A, gauze (control); group B, Mepilex™ (control); group C, 2.25% alginate hydrogel; and group D, 2.5% alginate hydrogel. The gross findings of each group were compared by tracing the remaining wound and performing visual and histological observations and biochemical analysis for proteins associated with wound healing at each time period. In burn wounds, groups C and D showed significantly higher contraction, epithelialization, and healing rates. Histologically, groups C and D showed an improved arrangement of collagen fibers and a thick epithelial layer 14 days after initial wound formation. Group C showed higher CD31, TGF-β, and fibronectin expression in Western blot analyses after day 14. This study suggests that the spray-type alginate hydrogel dressing is an effective material for initial burn wound care.
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Affiliation(s)
- Jeong Yeon Choi
- Advanced Mechatronics R&D Group, Daegyeong Regional Division, Korea Institute of Industrial Technology (KITECH), 320 Technosunhwan-ro, Yuga-eup, Dalseong-gun, Daegu 42994, Republic of Korea
| | - Yong-Joon Joo
- INCORE Co., Ltd., Hyeoksin-daero 78-gil, Dong-gu, Daegu 41070, Republic of Korea
| | - Ri Jin Kang
- INCORE Co., Ltd., Hyeoksin-daero 78-gil, Dong-gu, Daegu 41070, Republic of Korea
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu 41918, Republic of Korea
| | - Hee Kyung Jeon
- Advanced Energy Materials and Components R&D Group, Korea Institute of Industrial Technology (KITECH), 42-7, Baegyang-daero 804 beon-gil, Sasang-gu, Busan 46938, Republic of Korea
| | - Gyeong Sik Hong
- INCORE Co., Ltd., Hyeoksin-daero 78-gil, Dong-gu, Daegu 41070, Republic of Korea
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15
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Zahoor H, Javed N, Epperson JK, Ganguly D, Chung S, Khaja M. Cement-Induced Chemical Burn in a Middle-Aged Male: A Case Report and Review of Literature. Cureus 2024; 16:e53636. [PMID: 38449938 PMCID: PMC10917359 DOI: 10.7759/cureus.53636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
This case study reviews a 48-year-old Hispanic male working in construction who presented with left upper medial thigh pain, redness, and swelling after exposure to hazardous chemicals during cement processing. Initially diagnosed with cellulitis and adjacent myositis, the patient met sepsis criteria and received empiric antibiotics. However, negative cultures and an evolving wound appearance shifted the diagnosis towards bullous diseases and chemical injury. Occupational history and physical exam findings pointed towards injury secondary to chemical exposure, common in cement workers with inadequate protective gear. Cement burns, often insidious, are underreported due to their slow progression, mainly affecting the lower extremities. These burns involve chemical, mechanical, and hypersensitivity mechanisms that can mimic infection on imaging. This case highlights the importance of recognizing and managing cement burns promptly, emphasizing protective measures, decontamination, and potential early intervention by burn specialists.
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Affiliation(s)
- Hafsa Zahoor
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Jacob K Epperson
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Darshana Ganguly
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Susan Chung
- Surgery, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Misbahuddin Khaja
- Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
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16
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Tetri LH, Penatzer JA, Tsegay KB, Tawfik DS, Burk S, Lopez I, Thakkar RK, Haileselassie B. ALTERED PROFILES OF EXTRACELLULAR MITOCHONDRIAL DNA IN IMMUNOPARALYZED PEDIATRIC PATIENTS AFTER THERMAL INJURY. Shock 2024; 61:223-228. [PMID: 38010095 PMCID: PMC10922061 DOI: 10.1097/shk.0000000000002253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Background: Thermal injury is a major cause of morbidity and mortality in the pediatric population worldwide with secondary infection being the most common acute complication. Suppression of innate and adaptive immune function is predictive of infection in pediatric burn patients, but little is known about the mechanisms causing these effects. Circulating mitochondrial DNA (mtDNA), which induces a proinflammatory signal, has been described in multiple disease states but has not been studied in pediatric burn injuries. This study examined the quantity of circulating mtDNA and mtDNA mutations in immunocompetent (IC) and immunoparalyzed (IP) pediatric burn patients. Methods: Circulating DNA was isolated from plasma of pediatric burn patients treated at Nationwide Children's Hospital Burn Center at early (1-3 days) and late (4-7 days) time points postinjury. These patients were categorized as IP or IC based on previously established immune function testing and secondary infection. Three mitochondrial genes, D loop, ND1, and ND4, were quantified by multiplexed qPCR to assess both mtDNA quantity and mutation load. Results: At the early time point, there were no differences in plasma mtDNA quantity; however, IC patients had a progressive increase in mtDNA over time when compared with IP patients (change in ND1 copy number over time 3,880 vs. 87 copies/day, P = 0.0004). Conversely, the IP group had an increase in mtDNA mutation burden over time. Conclusion: IC patients experienced a significant increase in circulating mtDNA quantity over time, demonstrating an association between increased mtDNA release and proinflammatory phenotype in the burn patients. IP patients had significant increases in mtDNA mutation load likely representative of degree of oxidative damage. Together, these data provide further insight into the inflammatory and immunological mechanisms after pediatric thermal injury.
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Affiliation(s)
- Laura H Tetri
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford CA
- Department of Pediatrics, Stanford University, Stanford CA
| | - Julia A Penatzer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, Columbus OH
| | - Kaleb B Tsegay
- Department of Pediatrics, Stanford University, Stanford CA
- Department of Computer Science, Stanford University, Stanford CA
| | | | - Shelby Burk
- Department of Pediatrics, Stanford University, Stanford CA
| | - Ivan Lopez
- Department of Pediatrics, Stanford University, Stanford CA
| | - Rajan K Thakkar
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, Columbus OH
- Department of Pediatric Surgery, Burn Center, Nationwide Children’s Hospital, Columbus, OH
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17
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Stanton E, Karanas Y, Pham T, Gillenwater J, Sheckter CC. Inpatient Complications and Outcomes for Burn Patients Admitted with Methamphetamine Intoxication. J Burn Care Res 2024:irae014. [PMID: 38285638 DOI: 10.1093/jbcr/irae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Indexed: 01/31/2024]
Abstract
Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, little is known about the risks of amphetamine intoxication on inpatient complications and perioperative management. The US National Trauma Data Bank was queried for burn encounters between 2017-2021. Amphetamine intoxication was identified on admission. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure and surgical management. Multivariable regressions modeled outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied. Our study identified a total of 73,968 primary burn encounters with toxicology screens. Among these, 800 cases (1.1%) were found to have positive methamphetamine drug screens upon admission. Methamphetamine users were significantly older (41.7 versus 34.9 years, p<.001), had a greater percentage of males (69.6 vs. 65.4, p=.045), were more likely to have inhalation injury (p<.001) and had larger %TBSA burns (16% vs. 13%, (p<.001). Methamphetamine users were no more likely to die, experience MI, or experience stroke during admission. In contrast, methamphetamine users were significantly more likely to have alcohol withdrawal (p=.019), AKI (p<.001), deep vein thrombosis (DVT) (p=.001) , pulmonary embolism (PE) (p=.039), sepsis (p=.026), and longer ICU stays (p<.001). Methamphetamine use was associated with a longer number of days to first procedure (p=.005). Of all patients who required surgery (15.0%), methamphetamine users required significantly more total debridements and reconstructive procedures (p<.001). While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, DVT, AKI, sepsis, and longer ICU stays. Methamphetamine intoxication was associated with delays in surgical care.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Yvonne Karanas
- Regional Burn Center, Santa Clara Valley Medical Center, USA
| | - Tam Pham
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Clifford C Sheckter
- Regional Burn Center, Santa Clara Valley Medical Center, USA
- Department of Surgery, Stanford University, USA
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18
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van Balen NIM, Simon MH, Botman M, Bloemers FW, Schoonmade LJ, Meij-de Vries A. Effectiveness of prevention programmes on the rate of burn injuries in children: a systematic review. Inj Prev 2024; 30:68-74. [PMID: 38050048 DOI: 10.1136/ip-2022-044827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Burns are a frequent injury in children and can cause great physical and psychological impairment. Studies have identified positive effects of prevention measures based on increase in knowledge or reduction in hazards. The main goal of burn prevention campaigns, however, is to prevent burns. Therefore, this review is focused on the effectiveness of prevention programmes on the rates of burns in children. METHODS A literature search was performed on PubMed, Embase, CINAHL, Web of Science, Google Scholar and Scopus, including a reference-check. Included were studies which evaluated burn prevention programmes in terms of burn injury rate in children up to 19 years old. Studies specifically focused on non-accidental burns were excluded as well as studies with only outcomes such as safety knowledge or number of hazards. RESULTS The search led to 1783 articles that were screened on title and abstract. 85 articles were screened in full text, which led to 14 relevant studies. Nine of them reported a significant reduction in burn injury rate. Five others showed no effect on the number of burn injuries. In particular, studies that focused on high-risk populations and combined active with passive preventive strategies were successful. CONCLUSION Some prevention programmes appear to be an effective manner to reduce the number of burn injuries in children. However, it is essential to interpret the results of the included studies cautiously, as several forms of biases may have influenced the observed outcomes. The research and evidence on this subject is still very limited. Therefore, it is of great importance that future studies will be evaluated on a decrease in burns and bias will be prevented. Especially in low-income countries, where most of the burns in children occur and the need for effective prevention campaigns is vital.
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Affiliation(s)
- Nina I M van Balen
- Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Myrthe H Simon
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Matthijs Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Annebeth Meij-de Vries
- Department of Burns and Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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19
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Kiliç U, Tural Büyük E. The Effect of Using Virtual Reality Headset During Burn Dressing on Pain, Anxiety and Fear Felt in Children: A Randomized Controlled Trial. J Burn Care Res 2024:irae005. [PMID: 38224569 DOI: 10.1093/jbcr/irae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Indexed: 01/17/2024]
Abstract
This study was conducted to determine the effect of using VR during burn dressing on the level of fear, anxiety and pain that children would experience. This randomized controlled trial was conducted in a pretest-posttest design. Randomization of the participants(n=65) was performed with the block randomization method. Then, 33 children were included in the intervention and 32 children in the control group with simple sequential randomization. The study data were collected using the "Family and Child Personal Information Form", "Physiological Parameters Registration Form", "Wong-Baker Faces Pain Scale", "Children's Fear Scale" and "Children's Anxiety Meter-State". The Chi-square test, t-test, Shapiro-Wilk, mean, and percentile distributions were used for the data analysis. After dressing, the physiological parameters of the children who used VR were found to be within normal limits (HR:108.48±12.43-O2: 98.39±1.14) compared to the children who did not use (HR:117.38±15.25-O2: 97.81±1.35) (p<0.05). After the dressing, children using VR (0.85±1.23) were determined to have less fear than those who did not use them (3.03±1.06), and similarly, children who used VR (2.64±2.73) experienced less anxiety than those who did not use them (5.84±2.26). When the pain levels were evaluated, the VR group (1.79±2.04) was reported to feel less pain compared to the control group (5.50±2.36). The VR used by children aged 5-10 years during burn dressing has been found to affect their physiological parameters and is effective in reducing fear, anxiety and pain levels.
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Affiliation(s)
- Ummuhan Kiliç
- R&D and Projects Specialist, Samsun Provincial Health Directorate
| | - Esra Tural Büyük
- Department of Child Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
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20
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Alessandri Bonetti M, Jeong T, Stofman GM, Egro FM. A 10-Year Single- Burn Center Review of Free Tissue Transfer for Burn-Related Injuries. J Burn Care Res 2024; 45:130-135. [PMID: 37703393 DOI: 10.1093/jbcr/irad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 09/15/2023]
Abstract
Skin grafting is the mainstay treatment in burn patients. However, in the scenario of soft tissue deficit along with exposure of critical structures, free flap is the only reconstructive option to provide adequate coverage. The aim of the study is to review indications and surgical outcomes of burn patients requiring free tissue transfer. A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries between March 2012 and June 2023. A total of 13 patients required a free flap for their reconstruction. Eleven flaps were performed during the acute care and 2 were performed for delayed reconstruction. Patients were 69% males and 31% females, with a mean age of 45.5 ± 16 years and a mean BMI of 25.4 ± 6.5. The mean follow-up was 13.5 ± 13.9 months. Indications for free tissue transfer were bone exposure (92%) and severe neck burn contracture (8%). Overall complications rate was 54%. Complications included free flap loss (15%), hematoma (15%), vein thrombosis of the anastomosis (15%), infection (8%), amputation (8%), and wound healing issues (23%). Overall, 38% of the patients required re-operations including venous anastomosis revision, hematoma evacuation, debridement, skin grafting, and debulking. Although sometimes free flap remains the only reconstructive option in severe burn-related injuries, it is only rarely used. However, they carry a high risk of complications and should be considered only as the last resort for limb or life-threatening situations.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Tiffany Jeong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Guy M Stofman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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21
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Mortada H, Ali Zahreldin A, Shafiek Saleh M, Shahien M, Elfeky A, Ibrahim Abdelhamed A, Elaraby A, Elzalabany A, Samir Hammad Y, Elshennawy S. The Efficacy of Whole-Body Vibration in Managing Post burn Victims' Complications: A Systematic Review. J Burn Care Res 2024; 45:48-54. [PMID: 37791999 DOI: 10.1093/jbcr/irad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 10/05/2023]
Abstract
Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.
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Affiliation(s)
- Hossam Mortada
- Biomechanics Unit, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | | | - Marwa Shafiek Saleh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | - Amr Elfeky
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | | | - Ahmed Elzalabany
- Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
| | - Yara Samir Hammad
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Shorouk Elshennawy
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
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22
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Karahan S, Ay Kaatsiz MA, Erbas A, Kaya Y. A Qualitative Analysis on the Experiences of Mothers of Children in Burn Intensive Care Unit: "She burned on the outside, me inside...". J Burn Care Res 2024; 45:120-129. [PMID: 37625120 DOI: 10.1093/jbcr/irad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 08/27/2023]
Abstract
Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semistructured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; "first reactions to burn trauma" related to the awareness that the child has been burned, "being a mother in the burn intensive care unit" related to caring for the child as a companion in the burn intensive care unit, "coping" related to how they cope with the problems throughout the whole process, and "requirements" regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided.
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Affiliation(s)
- Sabri Karahan
- Surgical Nursing Department, Harran University Faculty of Health Science, 63100 Sanliurfa, Turkey
| | - Melike Ayça Ay Kaatsiz
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, 06100 Ankara, Turkey
| | - Atiye Erbas
- Surgical Nursing Department, Duzce University Faculty of Health Science, 81000 Duzce, Turkey
| | - Yunus Kaya
- Department of Child Development, Faculty of Health Science, Aksaray University, 68000 Aksaray, Turkey
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Rizk N, Crawford D, Karanas Y, Barnes C, Pham TN, Sheckter CC. Amphetamine Positivity Prior to Burn Surgery Does not Adversely Affect Intraoperative Outcomes. J Burn Care Res 2024; 45:17-24. [PMID: 37875155 PMCID: PMC11023316 DOI: 10.1093/jbcr/irad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 10/26/2023]
Abstract
The treatment of burn patients using amphetamines is challenging due hemodynamic liabilty and altered physiology. Wide variation exists in the operative timing for this patient population. We hypothesize that burn excision in patients admitted with amphetamine positivity is safe regardless of timing. Data from two verified burn centers between 2017 and 2022 with differing practice patterns in operative timing for amphetamine-positive patients. Center A obtains toxicology only on admission and proceeds with surgery based on hemodynamic status and operative urgency, whereas Center B sends daily toxicology until a negative test results. The primary outcome was the use of vasoactive agents during the index operation, modeled using logistic regression adjusting for burn severity and hospital days to index operation. Secondary outcomes included death and inpatient complications. A total of 270 patients were included, and there were no significant differences in demographics or burn characteristics between centers. Center A screened once and Center B obtained a median of four screens prior to the surgery. The adjusted OR of requiring vasoactive support intraoperatively was not associated with negative toxicology result (P = .821). Having a body surface area burned >20% conferred a significantly higher risk of vasoactive support (adj. OR 13.42 [3.90-46.23], P < .001). Mortality, number of operations, stroke, and hospital length of stay were similar between cohorts. Comparison between two verified burn centers indicates that waiting until a negative amphetamine toxicology result does not impact intraoperative management or subsequent burn outcomes. Serial toxicology tests are unnecessary to guide operative timing of burn patients with amphetamine use.
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Affiliation(s)
- Nada Rizk
- Department of Surgery, Stanford University School of Medicine, 770 Welch Road suite 400, Palo Alto, CA 94304, USA
| | - David Crawford
- UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA
- Department of Surgery, University of Washington, 325 9th Ave Seattle WA 98104, USA
| | - Yvonne Karanas
- Regional Burn Center, Santa Clara Valley Medical Center, 751 S Bascom Ave San Jose, CA 95128, USA
| | - Christopher Barnes
- UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA
- Department of Anesthesia, University of Washington, 325 9th Ave Seattle WA 98104, USA
| | - Tam N Pham
- UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA
- Department of Surgery, University of Washington, 325 9th Ave Seattle WA 98104, USA
| | - Clifford C Sheckter
- Department of Surgery, Stanford University School of Medicine, 770 Welch Road suite 400, Palo Alto, CA 94304, USA
- Regional Burn Center, Santa Clara Valley Medical Center, 751 S Bascom Ave San Jose, CA 95128, USA
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24
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Franco E, Kreichman R, Metanes I, Segal M, Nae B, Bryzgalin L, Zouboulis C, Har-Shai Y. Intralesional Cryosurgery of a Bulky Post burned Auricular Keloid and EAR-Q Patient-reported Outcome Measure Assessment. J Burn Care Res 2024; 45:246-249. [PMID: 37795836 DOI: 10.1093/jbcr/irad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 10/06/2023]
Abstract
Postburned auricular keloids are a challenging problem for the patient and physician. We describe a successful combined treatment of a bulky postburn auricular keloid employing intralesional cryosurgery followed by multiple W-plasty. An EAR-Q pre- and postoperative patient-reported outcome assessments have revealed a significant improvement in all ear parameters of appearance, adverse effects, and quality of life. This combined treatment might be added to the armamentarium of possible treatment modalities for this perplexing problem.
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Affiliation(s)
- Eyal Franco
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rita Kreichman
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Issa Metanes
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Miriam Segal
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Bluma Nae
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leonid Bryzgalin
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Christos Zouboulis
- Department of Dermatology, Venereology and Allergology/Immunological, Dessau Medical Center, Brandenburg Medical School, Dessau, Germany
| | - Yaron Har-Shai
- Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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25
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Rizk N, Rochlin D, Sheckter CC. Health Equity Ratings of U.S. Burn Centers-Does For-Profit Status Matter? J Burn Care Res 2024; 45:40-47. [PMID: 37930806 DOI: 10.1093/jbcr/irad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 11/08/2023]
Abstract
Achieving health equity is forefront in national discussions on healthcare structuring. Burn injuries transcend racial and socioeconomic boundaries. Burn center funding ranges from safety-net to for-profit without an understanding of how funding mechanisms translate into equity outcomes. We hypothesized that health equity would be highest at safety-net facilities and lowest at for-profit centers. All verified and non-verified American Burn Association burn centers were collated in 2022. Safety-net status, for-profit status, and health equity rating were extracted from national datasets. Equity ratings were compared across national burn centers and significance was determined with comparative statistics and ordinal logistic regression. On an equity grade of A-D (A is the best), 27.6% of centers were rated A, 27.6% rated B, 41.5% rated C, and 3.3% rated D. About 17.1% of all burn centers were designated as for-profit compared to 21.1% of centers that were safety-net. About 73.1% of safety-net centers scored an A rating, and 14.3% of for-profit centers scored an A rating. Safety-net centers were 21.8 times more likely (P < .001) to have the highest equity score compared to nonsafety-net centers. There was an 80% decrease in the odds of having a rating of A for for-profit centers compared to nonprofit centers (P = .04). Safety-net centers had the highest equity ratings while for-profit burn centers scored the lowest. For-profit funding mechanisms may lead to the delivery of less equitable burn care. Burn centers should focus on health equity in the triage and management of their patients.
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Affiliation(s)
- Nada Rizk
- Department of Surgery, Stanford University, 770 Welch Road #400, Palo Alto, CA 94304, USA
| | - Danielle Rochlin
- Department of Surgery, Stanford University, 770 Welch Road #400, Palo Alto, CA 94304, USA
| | - Clifford C Sheckter
- Department of Surgery, Stanford University, 770 Welch Road #400, Palo Alto, CA 94304, USA
- Department of Surgery, Regional Burn Center, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95128, USA
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26
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Hifny MA, Ogawa R. The Square-Plus Flap: A Modification to Release Long Post burn Scar Contractures. Arch Plast Surg 2024; 51:126-129. [PMID: 38425864 PMCID: PMC10901584 DOI: 10.1055/a-2189-9767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/07/2023] [Indexed: 03/02/2024] Open
Abstract
The square flap method has been successful in releasing contracture bands at various body regions. However, the original square flap method alone may not be efficient in releasing long contracture bands. We, therefore, proposed an extended design to the traditional design, which is called the "square-plus flap." A 4-year-old girl presented with a postburn web-like contracture band over the right axilla. We marked a square flap technique at the center of the contracture band and then two additional Z-plasties were placed on both edges of the flap. After the release and securing of the square flap, the adjacent distal Z-plasty was then transposed and sutured in their new locations. We do not need to incise the proximal Z-plasty as we could achieve complete relaxation of the contracture band. This novel modification can be added to the plastic surgeon's armamentarium for releasing long postburn contracture bands involving distinct body regions.
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Affiliation(s)
- Mahmoud A. Hifny
- Department of Plastic Surgery, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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27
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Chan RK, Nuutila K, Mathew-Steiner SS, Diaz V, Anselmo K, Batchinsky M, Carlsson A, Ghosh N, Sen CK, Roy S. A Prospective, Randomized, Controlled Study to Evaluate the Effectiveness of a Fabric-Based Wireless Electroceutical Dressing Compared to Standard-of-Care Treatment Against Acute Trauma and Burn Wound Biofilm Infection. Adv Wound Care (New Rochelle) 2024; 13:1-13. [PMID: 36855334 PMCID: PMC10654645 DOI: 10.1089/wound.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Objective: Despite advances in the use of topical and parenteral antimicrobial therapy and the practice of early tangential burn wound excision to manage bacterial load, 60% of the mortality from burns is attributed to bacterial biofilm infection. A low electric field (∼1 V) generated by the novel FDA-cleared wireless electroceutical dressing (WED) was previously shown to significantly prevent and disrupt burn biofilm infection in preclinical studies. Based on this observation, the purpose of this clinical trial was to evaluate the efficacy of the WED dressing powered by a silver-zinc electrocouple in the prevention and disruption of biofilm infection. Approach: A prospective, randomized, controlled, single-center clinical trial was performed to evaluate the efficacy of the WED compared with standard-of-care (SoC) dressing to treat biofilms. Burn wounds were randomized to receive either SoC or WED. Biopsies were collected on days 0 and 7 for histology, scanning electron microscopy (SEM) examination of biofilm, and for quantitative bacteriological analyses. Results: In total, 38 subjects were enrolled in the study. In 52% of the WED-treated wounds, little to no biofilm could be detected by SEM. WED significantly lowered or prevented increase of biofilm in all wounds compared with the pair-matched SoC-treated wounds. Innovation: WED is a simple, easy, and rapid method to protect the wound while also inhibiting infection. It is activated by a moist environment and the electrical field induces transient and micromolar amounts of superoxide anion radicals that will prevent bacterial growth. Conclusion: WED decreased biofilm infection better compared with SoC. The study was registered in clinicaltrials.gov as NCT04079998.
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Affiliation(s)
- Rodney K. Chan
- United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
| | - Kristo Nuutila
- United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
| | | | | | | | - Maria Batchinsky
- United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
| | - Anders Carlsson
- United States Army Institute of Surgical Research, Ft. Sam Houston, Texas, USA
- Metis Foundation, San Antonio, Texas, USA
| | - Nandini Ghosh
- Comprehensive Wound Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chandan K. Sen
- Comprehensive Wound Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sashwati Roy
- Comprehensive Wound Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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28
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Kochar SS, Athawale V, Fating T. Physiotherapy Approach in Transradial Amputation Following the Sequelae of Electric Burn: A Case Report. Cureus 2024; 16:e51731. [PMID: 38318553 PMCID: PMC10839547 DOI: 10.7759/cureus.51731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
A considerable amount of mortality and morbidity has been attributed to burn injuries. Because of expanding industrial development, greater consumption of electricity, and electric appliances at home, the number of burns caused by electricity is expanding. When it pertains to addressing burn injuries, therapeutic pursuits are necessary. The 18-year-old female patient in this case reported a history of burns due to electrical shock to her left upper and lower limbs along with her right foot. She came to the hospital, and after necessary investigations and examination, she was suggested for below elbow amputation or transradial amputation with debridement of the wound over the left axilla, foot, and right foot. Following the surgical procedure, the patient had pain, reduced muscle strength, limited joint mobility, and edema. For further rehabilitation, community health physiotherapy was advised. Routine physiotherapy treatment was provided to the patient for fifteen days. We report that after surgery, the effects of physical therapy showed decreased pain intensity, enhanced range of motion (ROM) of the affected and peripheral joints, and improved strength in adjacent muscles.
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Affiliation(s)
- Shraddha S Kochar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Athawale
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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29
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Zavala S, Pape KO, Walroth TA, Reger M, Hoyte B, Thomas W, Adams B, Hill DM. Vitamin D Deficiency Is Associated with Increased Length of Stay After Acute Burn Injury: A Multicenter Analysis. J Burn Care Res 2023:irad201. [PMID: 38141248 DOI: 10.1093/jbcr/irad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 12/25/2023]
Abstract
In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis and infectious complications. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). This was a multi-center retrospective study of adult patients at 7 burn centers admitted over a 3.5 year period, who had a 25-hydroxyvitamin D concentration drawn within the first 7 days of injury. Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring renal replacement therapy (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, vitamin D deficiency was associated with longer LOS. In conclusion, patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with non-deficient vitamin D concentrations.
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Affiliation(s)
- Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Kate O Pape
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA, United States
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, United States
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA, United States
| | - Brittany Hoyte
- Department of Pharmacy, Corewell Health, Grand Rapids, MI, United States
| | - Wendy Thomas
- Department of Pharmacy, Corewell Health, Grand Rapids, MI, United States
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL, United States
| | - David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN, United States
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30
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Araújo GDMS, Loureiro AIS, Rodrigues JL, Barros PAB, Halicki PCB, Ramos DF, Marinho MAG, Vaiss DP, Vaz GR, Yurgel VC, Bidone J, Muccillo-Baisch AL, Hort MA, Paulo AMC, Dora CL. Toward a Platform for the Treatment of Burns: An Assessment of Nanoemulsions vs. Nanostructured Lipid Carriers Loaded with Curcumin. Biomedicines 2023; 11:3348. [PMID: 38137569 PMCID: PMC10742090 DOI: 10.3390/biomedicines11123348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Curcumin is a highly promising substance for treating burns, owing to its anti-inflammatory, antioxidant, antimicrobial, and wound-healing properties. However, its therapeutic use is restricted due to its hydrophobic nature and low bioavailability. This study was conducted to address these limitations; it developed and tested two types of lipid nanocarriers, namely nanoemulsions (NE-CUR) and nanostructured lipid carriers (NLC-CUR) loaded with curcumin, and aimed to identify the most suitable nanocarrier for skin burn treatment. The study evaluated various parameters, including physicochemical characteristics, stability, encapsulation efficiency, release, skin permeation, retention, cell viability, and antimicrobial activity. The results showed that both nanocarriers showed adequate size (~200 nm), polydispersity index (~0.25), and zeta potential (~>-20 mV). They also showed good encapsulation efficiency (>90%) and remained stable for 120 days at different temperatures. In the release test, NE-CUR and NCL-CUR released 57.14% and 51.64% of curcumin, respectively, in 72 h. NE-CUR demonstrated better cutaneous permeation/retention in intact or scalded skin epidermis and dermis than NLC-CUR. The cell viability test showed no toxicity after treatment with NE-CUR and NLC-CUR up to 125 μg/mL. Regarding microbial activity assays, free curcumin has activity against P. aeruginosa, reducing bacterial growth by 75% in 3 h. NE-CUR inhibited bacterial growth by 65% after 24 h, and the association with gentamicin had favorable results, while NLC-CUR showed a lower inhibition. The results demonstrated that NE-CUR is probably the most promising nanocarrier for treating burns.
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Affiliation(s)
| | - Ana Isabel Sá Loureiro
- CEB-Center of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Jamile Lima Rodrigues
- Graduate Program in Food Science and Engineering, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | | | | | - Daniela Fernandes Ramos
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | | | - Daniela Pastorim Vaiss
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | - Gustavo Richter Vaz
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | - Virginia Campello Yurgel
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | - Juliana Bidone
- Center of Chemical, Pharmaceutical, and Food Sciences, Federal University of Pelotas, Pelotas 96010-610, RS, Brazil
| | - Ana Luiza Muccillo-Baisch
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | - Mariana Appel Hort
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
| | - Artur Manuel Cavaco Paulo
- CEB-Center of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Cristiana Lima Dora
- Graduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
- Graduate Program in Food Science and Engineering, Federal University of Rio Grande, Rio Grande 96203-900, RS, Brazil
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31
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Walters ET, Palackic A, Franco-Mesa C, Shah NR, Erickson MJ, Wolf SE. The impact of COVID-19 on clinical outcomes of burn patients. Burns Trauma 2023; 11:tkad042. [PMID: 38074193 PMCID: PMC10699731 DOI: 10.1093/burnst/tkad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 03/30/2023] [Accepted: 07/20/2023] [Indexed: 02/12/2024]
Abstract
Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517-2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798-4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351-4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326-4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.
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Affiliation(s)
- Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Michael J Erickson
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
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32
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Choi JY, Cha WJ, Kim J, Jung ER, Jung SN, Seo BF. Undifferentiated Pleomorphic Sarcoma of a Chronic Burn Scar of the Knee With Lymph Node Metastasis. INT J LOW EXTR WOUND 2023; 22:767-773. [PMID: 34791920 DOI: 10.1177/15347346211060125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant transformation of chronic burn scars are usually toward cutaneous lineages, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Sarcomas are less common. Undifferentiated pleomorphic sarcoma(UPS) is a subtype of soft tissue sarcoma with storiform-pleomorphic cells of uncertain origin, and has sparingly been reported to arise from burn scars. The majority are localized lesions probably due to the spatial distance of mesenchymal cells from the epithelium. The authors describe a rare case of UPS of the chronic burn scar of his knee with ipsilateral femoral and external iliac lymph node metastasis.
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Affiliation(s)
- Jong Yun Choi
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Jin Cha
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeeyoon Kim
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ee Room Jung
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung No Jung
- College of Medicine, The Catholic University of Korea, Seoul, Korea
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33
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Shields W, Dong Y, Jager L, Shiang E, Frattaroli S, Omaki E. Using the NEISS database to understand pressure cooker related injuries in the USA. Inj Prev 2023; 29:506-510. [PMID: 37666516 DOI: 10.1136/ip-2023-044910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging. METHODS The National Electronic Injury Surveillance System (NEISS) was queried to identify injuries associated with pressure cookers between 1 January 2003 and 31 December 2019. Case narratives were reviewed to identify precipitating or contributing factors of pressure cooker related injuries. Negative binomial regression was employed to test for trends over time. RESULTS The NEISS query identified 759 actual pressure cooker injuries between 2003 and 2019, yielding a national estimate of 28 337 (95% CI 24 588 to 32,086) injuries treated in US emergency departments, 1667 cases annually. Analysis of case narratives resulted in the identification of four predominant precipitating or contributing factors to injury: burning agent, struck by product, injured while opening and other. CONCLUSION NEISS is a valuable tool for determining injury incidence and understanding common injury patterns associated with specific products. Consumers and manufacturers of pressure cookers can develop safety strategies targeted at preventing the product's main injury risks.
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Affiliation(s)
- Wendy Shields
- Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yanan Dong
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Leah Jager
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Evelyn Shiang
- Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Frattaroli
- Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elise Omaki
- Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Baek C, Woolford L, Funnell O, McLelland J, Eddy S, Stephenson T, Speight N. Cutaneous and Respiratory Lesions in Bushfire-Affected Koalas. Vet Sci 2023; 10:658. [PMID: 37999482 PMCID: PMC10675647 DOI: 10.3390/vetsci10110658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
In the wake of increasingly frequent bushfires emerging as a threat to wildlife worldwide, koalas have notably been the most rescued species in Australia. However, our understanding of burns and their severity in koalas is limited; hence, this study investigated the histopathological features and depth of burns in koala skin, as well as the presence of smoke-induced respiratory tract damage. In four bushfire-affected koalas that had been euthanised on welfare grounds, skin burns in various body regions were scored based on clinical appearance as superficial, partial thickness, or full thickness. Histological sections of affected regions of skin were assessed as Grades I-IV and showed that furred regions on the ear margins and dorsum were histologically more severe, at Grade III, compared with the clinical score. There was a similar finding for footpad burns, which were the most common body region affected. In the respiratory tract, pulmonary oedema and congestion were evident in all koalas. Overall, the results highlight that cutaneous burn lesions on furred and palmar/plantar surfaces can have higher severity based on the burn depth than is clinically apparent. Therefore, there is a need to consider this when developing treatment plans and establishing prognosis for burnt koalas at triage, as well as that a high likelihood of pulmonary oedema exists.
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Affiliation(s)
- Chloe Baek
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Lucy Woolford
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Oliver Funnell
- Zoos South Australia, Frome Rd., Adelaide, SA 5000, Australia; (O.F.); (J.M.)
| | - Jennifer McLelland
- Zoos South Australia, Frome Rd., Adelaide, SA 5000, Australia; (O.F.); (J.M.)
| | - Stuart Eddy
- The Austin Vet Specialists, Adelaide, SA 5031, Australia;
| | - Tamsyn Stephenson
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Natasha Speight
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
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Won HS, Lee SH, Ahn YJ, Yang M, Kim YD. An Unexpected Complication Resulting from Radiofrequency Ablation for Treating Facet Joint Syndrome: A Case Report. Medicina (Kaunas) 2023; 59:1996. [PMID: 38004045 PMCID: PMC10673542 DOI: 10.3390/medicina59111996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Lumbar facet joints have been identified as a potential source of chronic low back pain (LBP) in 15% to 45% of patients, with the prevalence of such pain varying based on specific populations and settings examined. Lumbar facet joint interventions are useful in the diagnosis as well as the therapeutic management of chronic LBP. Radiofrequency ablation (RFA) of medial branch nerves is recognized as a safe and effective therapy for chronic facet joint pain in the lumbosacral spine, and its efficacy has already been established. The use of RFA is currently widespread in the management of spinal pain, but it is noteworthy that there have been works in the literature reporting complications, albeit at a very low frequency. We present a case of third-degree skin burns following radiofrequency ablation (RFA) for the management of facet joint syndrome. Postoperatively, the patient's skin encircling the needle displayed a pallor and exhibited deterioration in conjunction with the anatomical anomaly. The affected area required approximately 5 months to heal completely. During RFA, heat can induce burns not only at the point of contact with the RF electrode but also along the length of the needle. Vigilant attention is necessary to ensure patient safety and to address any potential complications that may arise during the procedure, including the possibility of minor technical errors.
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Affiliation(s)
- Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea; (H.-S.W.); (S.-H.L.)
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Shin-Hyo Lee
- Department of Anatomy, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea; (H.-S.W.); (S.-H.L.)
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Young Jean Ahn
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea;
| | - Miyoung Yang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea; (H.-S.W.); (S.-H.L.)
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
- Sarcopenia Total Solution Center, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Yeon-Dong Kim
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea;
- Wonkwang Institute of Science, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
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Joglar A, Song J, Golovko G, Jay J, Wolf S, El Ayadi A. Comparing the Effectiveness of Glucocorticoids in Preventing Hypertrophic Scar Diagnosis in Burn Patients. Medicina (Kaunas) 2023; 59:1970. [PMID: 38004018 PMCID: PMC10673324 DOI: 10.3390/medicina59111970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The prevalence of hypertrophic scarring after a burn is approximately 70%. Despite advances in burn management, there is currently no gold standard treatment to reduce or prevent its occurrence. Glucocorticoids are frequently given to patients early after burns for other therapeutic purposes and have been shown to induce scar regression. Therefore, the purpose of the present work is to determine the incidence of hypertrophic scar diagnosis in burn patients who were administered glucocorticoid treatment using TriNetX, a large patient database. Materials and Methods: Patients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of the skin after burn injury were identified in the TriNetX database. The glucocorticoids investigated include hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone. Patients were stratified into three groups based on total body surface area (TBSA) burned: 0-19%, 20-39%, and 40-100%. The risk ratio was evaluated for burn patients who received varying glucocorticoids after injury based on TBSA burned. Additionally, treatment pathways, time of treatment, and treatment purity pathways were evaluated. Results: In patients with a 0-19% TBSA burn, methylprednisolone showed a decreased risk of developing hypertrophic scar diagnosis. In those with a 20-39% TBSA burn or 40-100% TBSA burn, dexamethasone showed an increased risk of developing hypertrophic scar diagnosis. Additionally, dexamethasone was the most commonly administered glucocorticoid for burn patients and was most likely to be administered earlier after burn injury, comparatively. Conclusions: Methylprednisolone was associated with reduced hypertrophic scar diagnosis in burn patients independent of TBSA burn. While glucocorticoids are one of the mainstay treatments for hypertrophic scarring, further studies are needed to determine early therapeutic interventions that will reduce the potential for hypertrophic scar development in burn patients.
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Affiliation(s)
| | | | | | | | | | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA; (A.J.); (J.S.); (G.G.); (J.J.); (S.W.)
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Jung Y, Cui HS, Lee EK, Joo SY, Seo CH, Cho YS. Effects of Factors Influencing Scar Formation on the Scar Microbiome in Patients with Burns. Int J Mol Sci 2023; 24:15991. [PMID: 37958976 PMCID: PMC10648024 DOI: 10.3390/ijms242115991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Skin microbiome dysbiosis has deleterious effects, and the factors influencing burn scar formation, which affects the scar microbiome composition, are unknown. Therefore, we investigated the effects of various factors influencing scar formation on the scar microbiome composition in patients with burns. We collected samples from the burn scar center and margin of 40 patients with burns, subgrouped by factors influencing scar formation. Scar microbiome composition-influencing factors were analyzed using univariate and multivariate analyses. Skin graft, hospitalization period, intensive care unit (ICU) admission, burn degree, sex, age, total body surface area burned (TBSA), time post-injury, transepidermal water loss, the erythrocyte sedimentation rate, and C-reactive protein levels were identified as factors influencing burn scar microbiome composition. Only TBSA and ICU admission were associated with significant differences in alpha diversity. Alpha diversity significantly decreased with an increase in TBSA and was significantly lower in patients admitted to the ICU than in those not admitted to the ICU. Furthermore, we identified microorganisms associated with various explanatory variables. Our cross-sectional systems biology study confirmed that various variables influence the scar microbiome composition in patients with burns, each of which is associated with various microorganisms. Therefore, these factors should be considered during the application of skin microbiota for burn scar management.
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Affiliation(s)
- Yeongyun Jung
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - Hui Song Cui
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - Eun Kyung Lee
- Burn Institute, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (Y.J.); (H.S.C.); (E.K.L.)
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.Y.J.); (C.H.S.)
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Marzec L, Skotnicka-Klonowicz G, Sikora JP. Pain management in children with burns before admission to the ward: Analysis of selected parts of pre-hospital medical records. ADV CLIN EXP MED 2023; 32:1311-1317. [PMID: 37999637 DOI: 10.17219/acem/174814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The extent of pre-hospital medical care (PHMC) given to burned patients affects both the patient's condition and the effectiveness of treatment. OBJECTIVES To improve the quality of PHMC of burns in children, based upon an analysis of the selected parts of pre-hospital medical records, with particular emphasis on analgesia. MATERIAL AND METHODS Medical records were used to analyze how PHMC was given to 117 burned children aged 0-18 years, treated at the Pediatric Surgery Ward between January 1, 2014 and December 31, 2017. RESULTS In 41/85 cases, PHMC was delivered by Emergency Medical Teams (EMTs), in 42 in Emergency/Admission Rooms (ARs) and in 2 by Primary Health Care (PHC). Monotherapy was predominant. Medical records from ARs included the following information: the administration of analgesics with the name in 95% (21) of the cases, the route of drug administration in 45% (10), insertion of intravenous access and dressing in 33% (14), and fluid transfusion in 43% (6) cases. The way in which the EMTs provided assistance was described in 34% (14/41) of medical records, the administration of analgesics in 86% (12) cases, cooling and dressing in 43% (6), and the establishment of intravenous access with fluid transfusion in 36% (5) cases. CONCLUSION In burned children, access to analgesic and combined pain therapy is still random, limited and deviates from current recommendations. Prior to the admission to the ward, pain relief with 1 agent administered rectally prevails. There is a need to standardize the procedures for pre-hospital medical assistance provided to burned children, including the method of pain management in line with the Polish recommendations. It is necessary to make the medical staff aware of the obligation to keep medical records in a reliable and legal manner.
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Affiliation(s)
- Leszek Marzec
- Faculty of Medical and Health Sciences, State Vocational University of prof. Stanisław Tarnowski, Tarnobrzeg, Poland
| | | | - Janusz P Sikora
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Lodz, Poland
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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Establishment and validation of a nomogram to predict the neck contracture after skin grafting in burn patients: A multicentre cohort study. Int Wound J 2023; 20:3648-3656. [PMID: 37245866 PMCID: PMC10588345 DOI: 10.1111/iwj.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023] Open
Abstract
Cervical burn contracture is one of the burn contractures with the highest incidence and severity, and there is no effective method to predict the risk of neck contracture. This study aimed to investigate the effect of combined cervicothoracic skin grafting on the risk of neck contracture in burn patients and to develop a nomogram to predict the risk of neck contracture after skin grafting in burn patients. Data from 212 patients with burns who underwent neck skin grafting were collected from three hospitals, and the patients were randomly divided into training and validation sets. Independent predictors were identified through univariate and multivariate logistic regression analyses and incorporated into a prognostic nomogram. Its performance was assessed using the receiver operating characteristic area under the curve, calibration curve, and decision curve analysis. Burn depth, combined cervicothoracic skin grafting, graft thickness, and neck graft size were significantly associated with neck contractures. In the training cohort, the nomogram had an area under the curve of 0.894. The calibration curve and decision curve analysis indicated good clinical applicability of the nomogram. The results were tested using a validation dataset. Combined cervicothoracic skin grafting is an independent risk factor for neck contracture. Our nomogram demonstrated excellent performance in predicting neck contracture risk.
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Affiliation(s)
- Rui Li
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Xijuan Fan
- Department of Plastic SurgeryBeijing Ever Care Medical and Beauty HospitalBeijingChina
| | - Zilong Cao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Qiang Yue
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Jincai Fan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Cheng Gan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Hu Jiao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Liqiang Liu
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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Hamza Hermis A, Tehrany PM, Hosseini SJ, Firooz M, Hosseini SR, Jamshidbeigi A, Zaboli Mahdiabadi M, Ghorbani Vajargah P, Mollaei A, Karkhah S, Takasi P, Alizadeh Otaghvar H, Farzan R. Prevalence of non-accidental burns and related factors in children: A systematic review and meta-analysis. Int Wound J 2023; 20:3855-3870. [PMID: 37224877 PMCID: PMC10588353 DOI: 10.1111/iwj.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
Non-accidental burns (NABs) in children had some adverse effects, such as severe burns, requiring skin grafting, and mortality. Previous studies reported NABs in the form of neglect, suspected abuse, and child abuse. Also, different statistics were estimated for the prevalence of NABs in children. Therefore, the current study aimed to comprehensively review and summarise the literature on the prevalence of NABs in children. Also, factors related to NABs as a secondary aim were considered in this review. Keywords combined using Boolean operators and searches were performed in international electronic databases, such as Scopus, PubMed, and Web of Science. Only studies in English were considered from the earliest to 1 March 2023. The analysis was performed using STATA software version 14. Finally, 29 articles were retrieved for the quantitative analysis. Results found that the prevalence of child abuse, suspected abuse, neglect, 'child abuse or suspect abused', and 'abuse, suspect abused, or neglect' was 6% (ES: 0.06, 95% confidence interval [CI]: 0.05-0.07), 12% (ES: 0.12, 95% CI: 0.09-0.15), 21% (ES: 0.21, 95% CI: 0.07-0.35), 8% (ES: 0.08, 95% CI: 0.07-0.09), and 15% (ES: 0.15, 95% CI: 0.13-0.16) among burns victims, respectively. Also, factors related to NABs are categorised into age and gender, agent and area of burns, and family features. Considering the results of the current study, planning for rapid diagnosis and designing a process to manage NABs in children is necessary.
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Affiliation(s)
| | - Pooya M. Tehrany
- Department of Orthopaedic Surgery, Faculty of MedicineNational University of MalaysiaBaniMalaysia
| | - Seyed Javad Hosseini
- Department of Pediatric Nursing, School of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- School of Nursing and MidwiferyGolestan University of Medical SciencesGorganIran
| | - Seyed Reza Hosseini
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | - Amirreza Jamshidbeigi
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | | | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Hamidreza Alizadeh Otaghvar
- Department of Plastic Surgery, Trauma and Injury Research CenterIran University of Medical SciencesTehranIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
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Ahmed DR. The epidemiology of self-immolation in Iraq: A systematic review. Int J Soc Psychiatry 2023; 69:1551-1559. [PMID: 37139597 DOI: 10.1177/00207640231168787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Self-immolation is one of the most brutal suicide methods and is a significant social and medical problem throughout the world. Self-immolation is more common in low-income countries than in high-income countries. AIM The aim is to evaluate the trends in self-immolation and examine its frequency in Iraq. METHODS The PRISMA guideline was used to conduct this systematic review study. We searched for publications in English, Arabic and Kurdish in PubMed and Google Scholar. A total of 105 publications were identified through the search; however, 92 were eliminated due to duplication and irrelevant content. Finally, 13 full articles were included for data extraction. The inclusion criteria were articles that investigated self-immolation. However, letters to editors and media reports on self-immolation were excluded. The retrieved studies were selected, reviewed and then quality assessed. RESULTS This study included 13 articles. According to the findings, self-immolation accounted for 26.38% of all burn admissions in the Iraqi provinces and the Kurdistan region, with 16.02% of those occurring in the middle and southern provinces of Iraq and 36.75% in the Kurdistan region. It is more common in women than in men, especially among young, married, illiterate, or poorly educated people. Sulaymaniyah had a higher percentage of self-immolation than other governorates in Iraq, accounting for 38.3% of burn admissions. Cultural and social norms, domestic violence, mental health problems, family conflicts and financial problems were identified as the most common causes of self-immolation. CONCLUSION The prevalence of self-immolation is high among the Iraqi population, compared to other countries, particularly among the Kurdish population and in Sulaymaniyah. Self-immolation is relatively common among women. There are sociocultural factors that could contribute to this problem. Families must be restricted from having easy access to kerosene, and high-risk individuals should have access to psychological consultation to reduce the risk of self-immolation.
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Affiliation(s)
- Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya, Kurdistan Region - F.R., Iraq
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42
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Wang YQ, Wu ZH, Chen XJ, Ma H. Patient-reported outcomes and their predictors 2 years after burn injury: A cross-sectional study. Int Wound J 2023; 21:e14448. [PMID: 37864399 PMCID: PMC10828125 DOI: 10.1111/iwj.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
This study aimed to describe patient-reported outcomes 2 years after burn injury and to comprehensively elucidate predictors that may influence these outcomes. This cross-sectional, prospective study included 352 patients who were admitted to the Department of Burn Surgery at a tertiary teaching hospital between January 2017 and December 2020. We collected demographic and disease-related data and instructed participants to complete the Readiness for Hospital Discharge Scale (RHDS) and the Burn Specific Health Scale-Brief (BSHS-B) questionnaire. The overall score of patient-reported outcomes 2 years after burn injury was 126.55 ± 33.32 points, and the dimensions with the lowest scores were "hand function" (13.96 ± 5.75), "heat sensitivity" (14.84 ± 4.90), "treatment regimens" (13.41 ± 6.77) and "work" (11.30 ± 4.97). Multiple linear regression analysis revealed that less postburn pruritus, better readiness for hospital discharge, less total body surface area (TBSA), better social participation, white-collar jobs, older age, better sleep quality and burns not caused by electricity were associated with better outcomes. Patients experienced poor patient-reported outcomes 2 years after burn injury. Integrated rehabilitative care is necessary to address patients' unique needs and improve long-term patient-reported outcomes.
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Affiliation(s)
- Yan qiong Wang
- Department of Burn and Plastic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Zhi hui Wu
- Department of Burn and Plastic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Xiao juan Chen
- Department of Burn and Plastic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Hong Ma
- Department of Burn and Plastic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
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Evani SJ, Chen P, Karna SR, D'Arpa P, Leung KP. Cerium Nitrate Stiffens In Vitro Skin Models and Reduces Pseudomonas aeruginosa Pathogenicity and Penetration Through Skin Models. Adv Wound Care (New Rochelle) 2023; 12:546-559. [PMID: 36394961 PMCID: PMC10387153 DOI: 10.1089/wound.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Cerium nitrate (CeN) plus silver sulfadiazine (SSD) cream has been used for 40-plus years to manage burns. CeN produces a hardened eschar believed to resist bacterial colonization/infection. To evaluate this potential mechanism, we treated in vitro skin models or Pseudomonas aeruginosa with CeN and measured mechanical properties of the models and bacterial virulence, respectively. Approach: We treated three-dimensional-collagen matrix and ex-vivo-burned porcine skin with CeN and evaluated stiffness and P. aeruginosa penetration. In addition, we treated P. aeruginosa with CeN and evaluated the bacteria's motility, skin model penetration, susceptibility to be phagocytized by the human monocytic cell line THP-1, and ability to stimulate this cell line to produce cytokines. Results: CeN treatment of skin models stiffened them and made them resistant to P. aeruginosa penetration. Inversely, CeN treatment of P. aeruginosa reduced their motility, penetration through skin models (ex-vivo-burned porcine skin), and ability to stimulate cytokine production (tumor necrosis factor-α [TNF-α] and interleukin 8 [IL-8]) by THP-1 cells. In addition, CeN-treated Pseudomonas was more readily phagocytized by THP-1 cells. Finally, P. aeruginosa inoculated on CeN-treated ex-vivo-burned porcine skin was more susceptible to killing by a silver dressing. Innovation: In vitro skin models offer a platform for screening drugs that interfere with bacterial penetration into wounded tissue. Conclusion: CeN treatment reduced P. aeruginosa virulence, altered the mechanical properties of ex-vivo-burned porcine skin and collagen matrix, retarded penetration of P. aeruginosa through the skin models, and resulted in increased vulnerability of P. aeruginosa to killing by antimicrobial wound dressings. These data support the use of CeN in burn management.
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Affiliation(s)
- Shankar J. Evani
- Combat Wound Care Group, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Ping Chen
- Combat Wound Care Group, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - S.L. Rajasekhar Karna
- Combat Wound Care Group, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Peter D'Arpa
- Combat Wound Care Group, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Kai P. Leung
- Combat Wound Care Group, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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Yamashita K, Aoki K, Yokota A, Yamaguchi M, Konishi H, Ito N, Shimada K, Komiya T, Tettelbach W, Matsumura H. Deep palm burn treated with enzymatic debridement followed by autologous skin cell suspension: a case study. J Wound Care 2023; 32:S30-S34. [PMID: 37830845 DOI: 10.12968/jowc.2023.32.sup10a.s30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Despite improvements in treatment methods and outcomes, burns remain one of the principal causes of mortality and morbidity worldwide. Burns involving the hands are estimated to occur in >80% of people with burns. Hand burns have also been associated with long-term social, psychological and physical consequences that can impede a patient's full reintegration to the community and decrease their overall quality of life. Clinically, when the trajectory towards complete re-epithelialisation stalls in deep burn wounds of the hand, skin grafting is indicated, but cosmetic problems often remain. A recent publication highlighted common complications for burns involving the hand such as scar disturbances (26%) and scar contractures (14%). Innovative approaches with the potential to reduce the occurrence of complicating scar disturbances and contractures are sought by healthcare providers specialising in burns. This case report describes a novel approach to wound closure using a topical concentrate of proteolytic enzymes followed by the application of an autologous skin cell suspension. This combination was effective in achieving early and complete re-epithelialisation of a deep burn of the palm of a 28-year-old male patient, while potentially affording a favourable impact on hypertrophic scarring or scar contracture.
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Affiliation(s)
- Kento Yamashita
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kohei Aoki
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ayuka Yokota
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Mai Yamaguchi
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Konishi
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihito Ito
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuki Shimada
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takako Komiya
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - William Tettelbach
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, US
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
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Yazıcı H, Uğurlu O, Aygül Y, Yıldırım M, Deniz Uçar A. The effect of well-known burn-related features on machine learning algorithms in burn patients' mortality prediction. ULUS TRAVMA ACIL CER 2023; 29:1130-1137. [PMID: 37791433 PMCID: PMC10644077 DOI: 10.14744/tjtes.2023.79968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Burns is one of the most common traumas worldwide. Severely injured burn patients have an increased risk for mortality and morbidity. This study aimed to evaluate well-known risk factors for burn mortality and comparison of six machine learn-ing (ML) Algorithms' predictive performances. METHODS The medical records of patients who had burn injuries treated at Izmir Bozyaka Training and Research Hospital's Burn Treatment Center were examined retrospectively. Patients' demographics such as age and gender, total burned surface area (TBSA), Inhalation injury (II), full-thickness burns (FTBSA), and burn types (BT) were recorded and used as input features in ML models. Pa-tients were analyzed under two groups: Survivors and Non-Survivors. Six ML algorithms, including k-Nearest Neighbor, Decision Tree, Random Forest, Support Vector Machine, Multi-Layer Perceptron, and AdaBoost (AB), were used for predicting mortality. Several different input feature combinations were evaluated for each algorithm. RESULTS The number of eligible patients was 363. All six parameters (TBSA, Gender, FTBSA, II, Age, BT) that were included in ML algorithms showed a significant difference (p<0.001). The results show that AB algorithm using all input features had the best predic-tion performance with an accuracy of 90% and an area under the curve of 92%. CONCLUSION ML algorithms showed strong predictive performance in burn mortality. The development of an ML algorithm with the right input features could be useful in the clinical practice. Further investigations are needed on this topic.
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Affiliation(s)
- Hilmi Yazıcı
- Department of General Surgery, Marmara University, Pendik Training and Research Hospital, İstanbul-Türkiye
| | - Onur Uğurlu
- Faculty of Engineering and Architecture, Izmir Bakircay University, İzmir-Türkiye
| | - Yeşim Aygül
- Department of Mathematics, Ege University, İzmir-Türkiye
| | - Mehmet Yıldırım
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
| | - Ahmet Deniz Uçar
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
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46
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Barayan D, Khalaf F, Knuth CM, Abdullahi A, Rehou S, Screaton RA, Jeschke MG. Reply to Lund et al. Am J Physiol Endocrinol Metab 2023; 325:E423-E424. [PMID: 37812085 PMCID: PMC10642985 DOI: 10.1152/ajpendo.00283.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Dalia Barayan
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Fadi Khalaf
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Carly M Knuth
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Abdikarim Abdullahi
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Robert A Screaton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, Canada
| | - Marc G Jeschke
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
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Shahdadi H, Rezayi S, Shahrahmani F, Mohamadi AA. Photographic Evaluation of Burn Depth via Telemedicine: Insights from Iranian Surgeons. Telemed Rep 2023; 4:266-270. [PMID: 37753248 PMCID: PMC10518691 DOI: 10.1089/tmr.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
Background The accurate assessment of burn depth is crucial for determining appropriate treatment. Telemedicine has emerged as a promising tool for supporting burn diagnosis and decision-making, as it allows for remote consultation with burn specialists and access to high-quality imaging. The aim of this study was to evaluate the diagnostic capabilities of telemedicine in diagnosing burn depth. Methods A total of 15 Iranian surgeons participated in this study; they were presented with 13 images of partial thickness burn ulcers located on the extremities and trunk of patients. The participating surgeons were required to provide their diagnoses of burn type and depth, as well as the necessity of surgical intervention, and their responses were recorded. Results Data from 11 participants and 143 responses were analyzed. The average diagnostic accuracy for superficial burns was 79.3%, while for deep burns, it was 13.72%. The mean total diagnostic accuracy was 75.2%. Conclusion The results of this study suggest that photographs can be a reliable diagnostic tool for evaluating superficial burns. However, photographs are neither valid nor reliable for assessing burn depth. These findings have important implications for the use of telemedicine in burn diagnosis and indicate that additional diagnostic tools may be necessary for accurate assessment of deep burns.
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Affiliation(s)
- Hamed Shahdadi
- Department of Surgery, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Somayeh Rezayi
- Department of Nursing, Faculty of Nursing and Midwifery, Islamic Azad University of Khorasgan, Isfahan, Iran
| | - Fatemeh Shahrahmani
- Department of Surgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ali Akbar Mohamadi
- Department of Surgery, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
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48
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Stevens A, Waldrop C, Mandell S, Abdelfattah K, Arnoldo B, Akarichi CO, Clark AT. Fungal brain abscess in a severely burned patient. J Burn Care Res 2023; 44:1253-1257. [PMID: 37486798 DOI: 10.1093/jbcr/irad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 07/26/2023]
Abstract
Burn patients are particularly susceptible to atypical and opportunistic infections. Here we report an unusual case of a 40-year-old previously healthy man with a 74% TBSA burn injury who developed a presumed Fusarium brain abscess. This patient had a complicated infectious course including ESBL E. coli and Elizabethkingia bacteremia and pneumonia, MRSA ventilator-associated pneumonia, Mycobacterium abscessus bacteremia, and Fusarium fungemia. After diagnosis with a fungal abscess on magnetic resonance imaging of the brain, the patient was treated with aspiration and appropriate antifungal therapies. The patient was eventually transitioned to comfort care and died on hospital day 167. This is the first published report of a Fusarium-related brain abscess since it was first reported in a case report of a burned child in 1974.
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Affiliation(s)
- Audrey Stevens
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlyn Waldrop
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samuel Mandell
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kareem Abdelfattah
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett Arnoldo
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chiaka O Akarichi
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Audra T Clark
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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49
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Drwencke AM, Adcock SJJ, Tucker CB. Wound healing and pain sensitivity following caustic paste disbudding in dairy calves. J Dairy Sci 2023; 106:6375-6387. [PMID: 37268589 DOI: 10.3168/jds.2023-23238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023]
Abstract
Caustic paste disbudding is increasing in popularity on commercial dairy farms in the United States, but little research has explored the pain and welfare implications beyond the acute period of this procedure. In contrast, researchers have reported it takes 7 to 9 wk, on average, for hot-iron disbudding wounds to re-epithelialize in dairy calves. Our objective was to describe wound healing and sensitivity following caustic paste disbudding. Jersey and Holstein female calves were disbudded using caustic paste (H. W. Naylor Company Inc.) at 3 d of age (n = 18), and control calves received a sham procedure (n = 15). Before disbudding, calves received a local block and a nonsteroidal anti-inflammatory drug. Calves ≥34 kg and <34 kg at birth had 0.3 or 0.25 mL of paste applied per unshaved horn bud, respectively. Following disbudding, wounds were scored 2×/wk for the presence or absence of 8 tissue categories, including the final stages: new epithelium and fully healed. Control calves were removed from the experiment after 6 wk to be hot-iron disbudded. Mechanical nociceptive threshold (MNT) measures were collected weekly to evaluate wound sensitivity until calves were removed from the study or healed. Wounds were slow to re-epithelialize (16.2 ± 5.7 wk, mean ± SD; range: 6.2-32.5 wk) and contract to be considered fully healed (18.8 ± 6 wk, mean ± SD; range: 8.7-34.1 wk). Compared with non-disbudded controls, paste calves exhibited lower MNT values for all 6 wk (mean ± SE; control: 1.46 ± 0.16; paste: 1.18 ± 0.12 N). These data indicate that wounds from caustic paste disbudding are more sensitive than undamaged tissue for at least 6 wk and take twice as long to heal compared with cautery methods described in the literature. In conclusion, caustic paste disbudding wounds took 18.8 wk to fully heal and were more sensitive than intact horn buds for 6 wk. Future work should examine whether aspects of paste application (e.g., amount used, time rubbed in, calf age, pain mitigation) could improve healing time and sensitivity.
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Affiliation(s)
- Alycia M Drwencke
- Center for Animal Welfare, Department of Animal Science, University of California, Davis, CA 95616; Animal Behavior Graduate Group, University of California, Davis, Davis, CA 95616
| | - Sarah J J Adcock
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706
| | - Cassandra B Tucker
- Center for Animal Welfare, Department of Animal Science, University of California, Davis, CA 95616.
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50
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Bain AP, AbdelFattah KR, Clark AT. Rapid development of squamous cell carcinoma at a split-thickness skin graft donor site. Int J Burns Trauma 2023; 13:182-184. [PMID: 37736031 PMCID: PMC10509539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 09/23/2023]
Abstract
The development of a Marjolin ulcer at the site of a split-thickness skin graft donor site is exceptionally rare. Here we describe the rapid development of squamous cell carcinoma at a split-thickness skin graft donor site in the setting of severe burn. We present a case of a 52-year-old male with no past medical history who presented with a 24% total body surface area burn caused by a flash flame. Four months after his initial excision and grafting, he presented for revision of a burn scar with an additional complaint of a rapidly developing skin lesion at his donor site, which arose over 2 weeks. The lesion was excised en bloc and found to be invasive squamous cell carcinoma. There are 5 previous cases of squamous cell carcinoma development at the site of split-thickness skin harvest in the setting of severe burn. While the typical Marjolin ulcer has a latency period of up to 30 years, lesions that arise in split-thickness skin graft donor sites appear to have a rapid onset of weeks to months. Squamous cell carcinoma at the site of split-thickness skin grafting is an uncommon but important sequelae of burn care.
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Affiliation(s)
- Andrew P Bain
- Department of Surgery, University of Texas Southwestern Medical Center Dallas, TX, USA
| | - Kareem R AbdelFattah
- Department of Surgery, University of Texas Southwestern Medical Center Dallas, TX, USA
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern Medical Center Dallas, TX, USA
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